Understanding palliative care

Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

Currently, 40 million people worldwide could benefit from palliative care and yet less than 14% receive it. Among those in need of palliative care at the end of life, 78% are in low and middle income countries. Of the 54.6 million deaths in 2011, 66% of those were due to NCDs and life limiting disease.

Diseases requiring palliative care for adults:

Alzheimer’s and other dementias, different types of cancer, cardiovascular diseases (excluding sudden deaths), cirrhosis of the liver, chronic obstructive pulmonary diseases, diabetes, kidney failure, multiple sclerosis, Parkinson’s disease, rheumatoid arthritis, and drug-resistant AIDS.

Diseases requiring palliative care for children:

All cancers, cardiovascular diseases, cirrhosis of the liver, congenital anomalies (excluding heart abnormalities), blood and immune disorders, kidney diseases, neurological disorders and neonatal conditions, drug-resistant AIDS.

In Rwanda

In Rwanda, Since the publication of national palliative care (pc) policy in early 2011 with the mission of "All people with life-limiting illnesses in Rwanda will have access to quality palliative care services delivered in an affordable and culturally appropriate manner by 2020.”

Ministry of Health through the Rwanda Biomedical Centre adopted the implementation of the World Health Assembly Resolution of Integrating Palliative Care into the existing Health System and since then tremendous achievements have been observed.

Diane Mukasahaha, the National coordinator of palliative care, confirms that the burden of NCDs is growing with aging population, urbanization, globalization and the change in the life style leading to the need palliative care across the health system.

She says that "we aim to dignify the human being till death and with severe pain there is no dignity”

"…Prior to the 2014 development of its local morphine production program, the country’s dependence on imported morphine from foreign production and procurement chains created a extreme barrier: less than 0.1mg of morphine was given per capita and an estimated 98% of end of life pain was left untreated and now we are pleased to see the increase of usage from 35,500 mg in 2013 to 4,168,200mg in 2016 and the trend is tremendously increase as a proxy indicator of Palliative Care progress defined by WHO” she said.

"Our strategy is to challenge the barrier of "Go and die we have done all we can….” By reorienting its environment with philosophy said, " Put life into days not days into life…” by equipping providers to alleviate patient’s total Pain, including Physical, Emotional, social and spiritual and we have create Multidisciplinary teams for Palliative Care in all 42 District Hospitals and desks in charge of palliative Care in all referral and provincial Hospitals and avail at least 2 Nurses trained for Palliative Care in Health Centers. Palliative Care is all we do to improve the quality of life for the patient when the disease is not cured till the death; it goes beyond the patient care and considers the Family because most of those diseases took long and affect family members, and require the continuum of Care.

Palliative Care at home "a Rwandan innovation”

Palliative care can be accessed at all levels of the health system. with an aim to support the patients towards the end of life, we have started the Home based care practitioners program that will avail 2 trained home based care practitioners in Cell and provide basic palliative care at Home and will link patients with facilities in case of needs.

Maman Salam ( not her real name) is patient of Breast Cancer she have spent 2.5 years consulting tradition healers till she got to the hospital and knew that her cancer is at advanced phase, with metastatic in spinal cord which cause palarisy. She can now talk and explain what is happening to her because of pain medication at home she can now sit because of nursing care at home, she can moved to the sun and keep the neighbor’s child while she went to her work.

During the Policy dissemination it was like defending impossible in Africa and now I can see Palliative Care happening in Rwanda with my own eyes…’’ I’m a proudly Rwandan Diane

Magnus Udahemuka from University Teaching Hospital of Kigali says the first place which is conducive to manage patients who need palliative care is the community which serves to relieve patients of social and psychological burdens. The second one, he says, is hospices, while hospitals come in the third place.

Ministry of Health with its partners designed the Home-Based Care Practitioners (HBCP) programme that enables the development of scalable model, a task shifting initiative which redistributes palliative care services, follow-up services for stable NCDs patients, community-based NCDs educational activities, and performance of verbal autopsies to a new type of provider of care at home and have started providing palliative care at home.

The writer is the senior officer, diabetes, chronic diseases and other metabolic diseases at Rwanda Biomedical Centre